The Intern Blues(17)

There’s something about Mark I noticed very early in the month. It’s a funny thing: There are some people who look great after a night on call. No matter how many admissions come in and how little sleep they get, these people look unbelievably good the next day. Mark is definitely not one of these people. He had a couple of bad nights during July, and this was readily apparent in his appearance the next morning: His eyes were very droopy; his reddish-blond hair was uncombed and shot straight up in the air in all directions; and his clothes looked as if they’d been slept in, which obviously was not the case because Mark always claimed that he hadn’t gotten any sleep at all.

Amy Horowitz didn’t really decide to come to Schweitzer; she decided to stay here. She had been a medical student in the Bronx and had stayed on because she liked the program and felt comfortable with the people. She’s always lived in the New York metropolitan area. Born in Morristown, New Jersey, she was her parents’ only child. Her father owns an office supply business.

I’ve known Amy for a little over a year. In March, when she was in the ninth month of pregnancy, she told me that she’d thought a lot about being an intern and having a young baby but was somewhat concerned that she wouldn’t have time to be both a good intern and a good mother. But she’s convinced she can do it. It’s because of this conflict that Amy’s the one intern in the entire incoming group about whom I’m truly worried.

Early in the month, a crisis developed involving Amy. While working in the emergency room at Jonas Bronck, she was told by one of the attendings to get some blood tests on a patient. Amy swears that she drew the blood and sent it off to the lab. The attending, in checking on the situation a little later, could find no evidence that the lab had received the specimen or even that the blood had been drawn. He confronted Amy and, when she affirmed that she had done what was requested, he accused her of lying.

Whether this is true or not, lying about lab results is about the worst sin a house officer can commit. The implications are far-reaching. First, although our department is immense, word of mouth travels like wildfire, and within three days of this incident, rumors about Amy had already reached every member of the outpatient faculty. Second, and more importantly, whether she was guilty or not, Amy has lost a great deal of credibility. Interns have to be trusted. Although life-and-death decisions are always made by more senior physicians, such as attendings or chief residents, interns must be expected to function fairly independently with only occasional supervision when it comes to performing the more mundane, everyday types of activities, such as drawing blood, checking lab results, ordering tests, or making appointments for their patients. Amy’s ability to function independently has been called into question. Whether she drew that blood or not, Amy probably will have an attending or senior resident perched over her shoulder at all times to make sure she does what she’s supposed to do, at least for the immediate future. Amy is smart and a reasonably good worker, and within a month or so she’ll probably make everyone forget that this happened. But if she screws up just one time, she’s going to get nailed. And that could be it for her for the rest of this year.

I’m pretty sure Andy Baron doesn’t want to be in the Bronx. I think he was one of those people who had a major anxiety attack when he opened his Match envelope last March and found out he was coming here. I don’t think he objected because of our program. It’s just that he never thought he would actually have to leave Boston.

Except for college at Princeton, Andy’s spent his whole life around the Boston area. He returned to that city after college, attended medical school at Tufts University, and vowed that he’d never leave again. He told me he ranked Boston Children’s Hospital first on his list, and he’d been led to believe that getting in there wouldn’t be a problem. So you might say he was more than a little surprised when he found out he hadn’t matched there.

I think leaving Boston will have a major impact on Andy. Back home he had a very structured and broad-based support network. His family and friends are there, and, most importantly, so is Karen.

Karen Knight is the woman Andy’s lived with for the past year. Karen is a fourth-year medical student at Tufts; she’s going to have to spend a good portion of the year there. Andy has told me repeatedly that their relationship is strong, that it had lasted through a lot of adversity in the past, and that he feels it will easily be able to weather this year of separation. It sounds almost as if he were willing it to be that way.

And what was waiting for Andy here in New York? Almost nothing; there are a few friends who attended college with him, but nobody close who would understand or be there when things start getting rough. Internship is hard enough when you have a lot of love and support to help you through; it’s nearly impossible when you have to go it alone.